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�� APPI ICATIQni pno oir_ur .,� ..�... ...,_ ____.._ <br /> ���•� 'vr-YYHT UJC YChSIVl11 <br /> � _. '.! ' . ,_ <br /> CITY ENGINEERS � <br /> EVERETT, WqSHINGTON PERMIT NO. <br /> The Undersigned � <br /> Hereby applies for permission to �..; �� <br /> At the following location � — <br /> SKETCH <br /> (Work to be dnne) <br /> I <br /> l <br /> . DRWEWAv SECTION The undersigned owner hereby agrees to hold and <br /> NO SCALE save harmless the City of Everett from any and all <br /> . ___.—_. . __� <br /> ' _ I claims for dam�ges that may arise because of installa� <br /> � i f' LIP �� tion and maintenance of the improvement hereto <br /> ��30" I gp�� I applied for and fur[her agrees ,o remove same upon <br /> � —�t' ���'1 notice from [he City and to replace public properb/ <br /> damared thereby. , �. <br /> �; . <br /> . Signature of Applicant '� ' - � � ' <br /> v � <br /> COPY Of- TFIIS APPLIC.qTIOD: ;ti � Address � - <br /> I BE POSTED ON JOBSITE. _ . . . ., <br /> �� .;+L� oP,'GIPJE[RING DGPI 159 ;';I I �. Telephone Num6er <br /> � - ��. `;O�iR`i f3EFOHECONSTi?UC110��:, Date <br />' CHECK UST Fee <br /> i <br />� Water Valve <br /> i <br /> I Drainage Dept. Approvals <br /> I Curb & Gutter � <br />� Sidewalk :. . F.ngineers� ;; _� � <br /> . - � ..�c � �Natrr � - . <br /> , .. � � , . � � � ��� � .: . Street. . <br /> Inspector's Signature <br /> - -- � � Gcmmunications <br /> Traffic <br /> Planning <br /> —6ate — <br /> Remarks — ' <br /> Note: Original to Customer — <br /> 1 Copy to File "� ���%� n <br /> 1 Copy to Inspr.ctor - � � � � �� - <br /> Approved by <br />� n�,� n... .--.--- � <br /> - .i•i,f...�., <br /> I <br />